Skills competency in nurse education: nurse managers' perceptions of diploma level preparation

A Survey Study of Public Health Nurses’ Knowledge in Disaster Management in Indonesia

AIM: This descriptive survey study examines the level of public health nurses’ (PHNs) knowledge regarding disaster management. The knowledge was examined according to three disaster phases, including preparedness, response, and recovery phase. MATERIALS & METHODS: A stratified proportionate random sampling method was employed to recruit 252 PHNs of Aceh Province, Indonesia. The data were collected during November and December of 2010 by using the questionnaire developed by the researchers. They were analyzed using frequencies, percentages, means, standard deviations, and minimum and maximum scores. Additional analyses were performed to identify potential contributing factors to the PHNs' knowledge using the Spearman rank correlation (rs) and the Mann-Whitney U test. RESULTS: The finding showed that PHNs' knowledge in disaster management was moderate (M=70.73%, SD=8.41), and nearly half of the subjects (42.5%) were categorized in this level. The lowest mean score was found in the response phase (64.75%), and four items with the lowest percentage of correct answers were also found in this phase. CONCLUSION: The low level of knowledge for the response phase can be used to flag health policymakers and public health centers (PHC) to develop appropriate educational training and disaster drills for PHNs in collaboration with stakeholders in the community.

Nurses' perceptions of personal attributes required when working with people with a learning disability and an offending background: a qualitative study

WHAT IS KNOWN ON THE SUBJECT?: Learning disability nursing in the area of people with a learning disability and an offending background has developed considerably over recent years, particularly since the publication of the Bradley (). There has been limited work into the competencies nurses require to work in this area, and even less about the personal attributes of learning disability nurses. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: Learning disability nursing's specific contribution to the care of this population lies in their knowledge of the interaction between the learning disability, an individual's, sometimes abusive, personal history and an understanding of the subsequent offending behaviour. The knowledge base of nurses working with people with learning disabilities and an offending background needs to reflect the changing service user group. This is particularly in relation to substance misuse, borderline personality disorder, and mental health and the way such factors inter-relate with the learning disability. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Further research is required into the relationship among decision making, risk taking or reluctance to do this, and the personal attributes required by nurses to work in secure learning disability care. Learning disability secure services are likely to continue to undergo change as circumstances alter and the offending population demonstrate greater complexity; nursing competencies and personal attributes need similarly to adapt to such changes. Mental health nursing has a great deal to contribute to effective working with this population, specifically with regard to developing strong relationships when concerns around borderline personality disorder or substance misuse are particularly in evidence.

ABSTRACT

Aim To identify and discuss the personal attributes required by learning disability nurses to work effectively with people with an offending background in secure and community settings. Background This study was part of a larger research investigation into the nursing competencies required to work with people with an offending background. There are few existing studies examining the personal attributes necessary for working with this group. Design A qualitative study addressing the perceptions of nurses around the personal attributes required to work with people with learning disabilities and an offending background. Methods A semi-structured interview schedule was devised and constructed, and 39 individual interviews were subsequently undertaken with learning disability nurses working in high, medium, low secure and community settings. Data were collected over 1 year in 2010/11 and analysed using a structured thematic analysis supported by the software package MAXqda. Findings The thematic analysis produced three categories of personal attributes, named as looking deeper, achieving balance and connecting, each of which contained a further three sub-categories. Conclusion Nursing of those with a learning disability and an offending background continues to develop. The interplay among personal history, additional background factors, nurses' personal attributes and learning disability is critical for effective relationship building.

An evaluation of a critical care course for undergraduate nursing students

AIM

The aim of this paper was to evaluate a 2-day critical care course (CCC) delivered to a cohort of adult branch nursing students.

BACKGROUND

In today's health care system there is an increase in the number of critically ill patients being cared for in a ward environment. As a result, nurses require the knowledge and skills to effectively manage this patient group. Skills such as prompt recognition of the sick patient, effective communication and performing basic management care skills are necessary.

METHODS

The CCC was provided to final year adult branch nursing students (n = 182) within a university in the UK. On completion of the course, participants were invited to undertake a Likert scale questionnaire. The questionnaire also contained a free response section to elicit qualitative information. Quantitative data were analysed using SPSS version 17.0 and descriptive statistics produced. Qualitative responses were analysed thematically.

RESULTS

There was a 73.7% (n = 135) response rate. Overall, there was a positive evaluation of the course. Students (89.6%; n = 121) reported a perceived increase in confidence when caring for critically ill patients following the course and 88.2% (n = 119) felt that their knowledge and skills had improved at the end of the 2-day course.

CONCLUSION

This study supports the implementation of critical care training for undergraduate nursing students. There are implications for the development of specific modules, aiming to improve undergraduate nursing students' recognition, assessment and management of the critically ill patient.

RELEVANCE TO CLINICAL PRACTICE

There is a shortage of critical care practice placements for undergraduate nursing students. It is essential that an undergraduate curriculum incorporates critical care teaching so that critical care skills are evident at the point of registration.

Students' perspectives on their skills acquisition and confidence

AIM

To investigate students' perspectives on their skills acquisition and knowledge during the foundation year of their nursing programme, and whether this improved students' levels of competence and confidence.

METHOD

Two groups of nursing students (n=140) responded to a clinical acquisition skills survey (CASS) to elicit their perceptions of clinical skills acquisition. Additionally, students' competence levels were examined, drawing comparisons with the students' objective, structured clinical examination (OSCE) results.

RESULTS/FINDINGS

Students identified that the curriculum supported the acquisition of clinical skills, and clinical examination results confirmed that 95% of students were competent to pass their OSCE.

CONCLUSION

Students' responses to items that related to perceived confidence and competence levels were positive. This indicates that the introduction of clinical skills teaching and assessment within a university's simulation suites augmented with structured assessment within the clinical environment improved the acquisition of clinical skills.

In search of a Croatian model of nursing education

AIM

To analyze the present status and ongoing reforms of nursing education in Europe, to compare it with the situation in Croatia, and to propose a new educational model that corresponds to the needs of the Croatian health care system.

METHODS

The literature on contemporary nursing education in Europe and North America was reviewed, together with European Commission directives and regulations, as well as pertinent World Health Organization documents. In addition, 20 recent annual reports from 2003-2009, submitted by national nursing associations to the Workgroup of European Nurse Researchers (WERN), were studied.

RESULTS

After appraisal of current trends, the Working Group on Reform of Nursing Education drafted The Croatian Model for Education in Nursing and developed a three-cycle curriculum with syllabus. The proposed curriculum is radically different from traditional ones. Responding to modern demands, it focuses on outcomes (developing competencies) and is evidence-based.

CONCLUSIONS

A new, Croatian concept of nursing education is presented that is concordant with reforms in nursing education in other European countries. It holds promise for making nursing education an integral part of a unified European system of higher education.

Acute nursing episodes which challenge graduate's competence: perceptions of registered nurses

On successful completion of nurse education programmes new graduate nurses are expected to meet the requirements for registration as a professional practitioner. Nurse educators need to collaborate with clinical colleagues to be responsive to changes in health care. Identifying challenging acute nursing episodes (CANE) that nurses' encounter in clinical practice and the aspect of competence that new graduate nurses require to manage these episodes effectively can inform undergraduate nursing curricula. Thus a qualitative, descriptive design was employed when undertaking a study to identify challenging acute nursing episodes which new graduates will encounter in clinical practice. Six focus groups were conducted in three university teaching hospitals in Ireland where a total of 28 registered nurses were recruited. Thematic analysis was used to extract themes from the focus group data. The results of this study identified 41 challenging acute nursing episodes and 4 key aspects of competence namely; patient assessment, technical/clinical skills; interactions and communications and clinical decision making. Findings of this study identify both the episodes which challenge new graduates and aspects of competence required by new graduates. These findings provide evidence for nurse educators to develop and deliver curricular content which is congruent with the realities of current day nursing practice.

'They don't know much about us': educational reform impacts on students' learning in the clinical environment

Placements are an integral component of the medical, nursing, and allied health curriculum. Literature on problem-based learning indicates that curriculum change can impact student experience. However, outside of the nursing literature, there is little research on the impact of education reform on students' experiences of placements. This paper reports on medical, midwifery and paramedic students' perception of the impact of education reform they experienced in the clinical setting. A qualitative study using a semi-structured schedule was conducted. Data was collected using focus groups (17), individual interviews (48) and written responses (2) from undergraduate students (103) and graduates (27) from a tertiary institution in Victoria, Australia. Recorded interviews were analysed, coded and categorised into themes. Whilst students indicated they were prepared for the impact of educational reform on their placement experience, they perceived that clinical educators responsible for teaching them were less prepared. Three themes were identified from the data: clinical educator's lack of familiarity with new curriculum, clinical educator's negative attitudes to curricular change and looking to the future. Our study advances the understanding of the implications of education reform during the clinical placement of medical, midwifery, and paramedic students. Whilst important lessons can be learned from the medical and nursing literature this study highlights that staff responsible for curriculum change need to action change management process to ensure that the clinical educators are able to deliver the revised program.

A review of curriculum evaluation in United Kingdom nursing education

Recently we have witnessed several significant changes to the nursing curriculum in the United Kingdom (UK). This review forms part of a larger study evaluating the 'fitness for practice' elements of the nursing curriculum in Scotland. Systematic review methods were used including the following databases: CINAHL and BNI. Twenty six papers were retrieved and 14 remained after applying the review criteria, the main rationale being the empirical focus. It appears that there is a paucity of research in this area in the UK and papers dealt exclusively with either content, process or outcome evaluation of the nursing curriculum. National, well funded, multi-centre studies tended to be more rigorous. Results, where they were positive about curricular changes, tended to be limited. There is clearly a need for rigorous research into curriculum evaluation, both at the micro and macro level, which investigates content, process and outcome. Without such research, curriculum change will be uninformed.

A survey of first year student nurses' experiences of learning blood pressure measurement

Blood pressure (BP) measurement is an important clinical nursing skill. Informal evaluation triggered concerns about first year student nurses' opportunities to practise it. Therefore 447 first year pre-registration nursing students completed evaluative questionnaires following two 6-week clinical placements. The data were analysed using SPSS v.13 for analysis; open comments were analysed thematically. A third of the respondents (n=137) had pre-course experience in measuring BP. Ninety-five percent (n=425) attended the university skills laboratory session. Only 36% (n=158) of students measured BP using both electronic and manual equipment in both placements and 6% (n=27) did not practise this skill in either placement. Students undergoing non-hospital placements reported fewer practice opportunities. A large number of students reported never having been supervised while measuring BP; they were more likely to be supervised while measuring BP manually than electronically. Students' self-confidence in BP measurement increased over the first year but larger number of students were confident in electronic BP. To conclude, experiences of learning BP measurement varied in terms of opportunities to practise, equipment used, supervision levels and self-confidence. Students' experiences of learning other clinical skills may also differ, which has implications for healthcare education generally.

I felt like a real nurse - student nurses out on their own

In the United Kingdom, the education of nurses to be 'fit for practice' has received considerable attention having a catalytic effect on the way nursing programmes are organised. A period of clinical practice is now recommended in the final stages of nurse education to help prepare students for the role of registered practitioner. In the study area, the opportunity for student nurses in the final stages of their programme to visit patients and clients on their own in the community is given to facilitate achievement of the competencies required for entry to the nursing register. The aim of the study reported here was to discover what this experience meant for students in their final year. A qualitative methodology utilising one-to-one, semi-structured interviews was adopted. The tape-recorded interviews were transcribed and the content analysed to reveal codes, categories and themes. The findings revealed that being 'out on their own' was valued by students who felt they were taking on the role of a 'real nurse'. The main themes to emerge were: building confidence, developing professionalism in relationships, learning to manage care, developing knowledge and gaining insight, and being included and supported. The opportunity for final stage students to work independently in whatever setting they are placed is recommended as important for their professional development.

The debate in favour of using simulation education in pre-registration adult nursing

The purpose of this paper is to have a fresh look at the literature on the advantages and disadvantages of simulation education as a teaching, learning and assessment methodology within pre-registration nurse education. It will highlight the reasons why simulation education has been re-introduced into nurse education within many Higher Education Institutions (HEI) in the United Kingdom (UK). This is in an attempt to enable the student nurse to develop competence in the clinical skills required for fitness for award, practice and purpose. This comes at a time when the Nursing and Midwifery Council (NMC) are conducting further research on simulation education and whether it can replace practice hours.

Facing registration: the expectations and the unexpected

This paper reports on newly qualified nurses' experiences of the transition from being a nursing student to becoming a registered nurse. The aim of the study was to ascertain how newly qualified nurses perceived their role transition in an Irish general hospital. Data were gathered using in-depth interviews with 12 nurses who were within one year of qualification. A grounded theory approach was used to generate, analyse and synthesise the data. The findings revealed that newly qualified nurses have specific needs, many of which are unrealised. The vast and increased workload, which involved less patient-contact and more non-nursing duties, came as a surprise to participants in this study. The expectation of in-depth knowledge, coupled with feelings of increased responsibility and compounded by relatively little experience did little to ease the transition to becoming a newly qualified nurse. There is a need to contextualise the transition to registration so that expectations of newly qualified nurses are realistic. Management and staff must remain cognisant of the fact that many newly registered nurses have relatively limited clinical experience at the time of registration.

An examination of the scope and purpose of education in mental health nursing

This study examined the education of mental health nurses by surveying all qualified mental health nurses working within one National Health Service region in Scotland. Using an adaptation of a previously used instrument, 488 questionnaires were distributed producing a response rate of 194 (39.75%). The study's themes - initial preparation, professional development and future practice - reveal findings of interest, particularly the axis of RMN (pre-1992 education) and RMN (Project 2000 education). In terms of initial preparation, clear differences between groups were found. Pre-1992 RMNs' report on educational experience majoring on practical skills contrasts sharply with Project 2000 respondents who, in spite of a course philosophy of reflective practice, emphasised an apparent lack of practical skills for practice. For professional development, both groups valued flexible approaches via journal reading, teaching, networking and participating in clinical supervision. In terms of educational provision, short course provision with an emphasis on short, flexible course provision (e.g., in-service study days), practice education and closer (and flexible) links between higher education and the practice area were highlighted as the most important ways to prepare for future practice.

Reforming the Swiss nurse education system: A policy review

BACKGROUND

Western Europe has been swept in the last three decades by ongoing reforms within the nurse education systems. Within the Western European region, Switzerland is one of the last countries initiating the integration of nursing programs into higher education institutions.

OBJECTIVES

This article examines the nurse education reforms recently enacted in Switzerland. The specific aims of the analysis were to: (a) examine modes of reform implementation and the current status of the Swiss nurse education system; (b) compare between two new Swiss nurse education models developed in the various linguistic regions.

METHOD

A documentary search for policy documents, reports and studies related to the implementation processes of reforms was conducted through websites of various legal institutions and the Swiss university library system.

FINDINGS

The analysis indicated that although a fit between environmental pressures and the reform agenda exists, the implementation of the nursing reform varied considerably between the various Swiss linguistic regions. This variation resulted in two newly created models of nurse education programs revealing a high level of variability and inconsistency. As such, the development of a unified system of nurse education, which was set as the primary goal of the reformed system, was not achieved.

CONCLUSIONS

Overall, Switzerland is contributing to the widening heterogeneity rather than to the aspired homogeneity across Western European countries.

Professional socialization: The key to survival as a newly qualified nurse

The impact and prevalence of professional socialization in nursing has been written about extensively. Despite the many positive developments that have taken place in nursing within the past decade, the role of professional socialization remains heavily weighted and is of particular significance to those nurses who are newly qualified. The account given by newly registered nurses in this study demonstrates that their ability and willingness to become professionally socialized determines their ease of survival at clinical level. Twelve newly qualified Irish nurses, from two separate cohorts, were interviewed to ascertain their perceptions of becoming newly qualified nurses. A grounded theory approach was used and data were analysed using thematic analysis. A category that emerged was linked very strongly with professional socialization. The respondents did not refer to professional socialization per se, but through the coding process this emerged as the linchpin of the discussion.

Nurse teachers' knowledge in curriculum planning and implementation

BACKGROUND

Nurses are required to base care on research evidence but research findings on nursing practice often suggest that the linkage is poor and ritualistic routines often prevail.

AIMS

The study explored the origin and nature of knowledge utilised by nurse teachers when developing and implementing a curriculum.

METHODS

In a single, ethnographic case study data were collected from two curriculum development and two curriculum implementation groups, using interviews, participant observation and documents. The study drew directly on Bernstein's theory of the pedagogic device and cultural reproduction.

RESULTS

Findings suggested that even though nurse education appears to be dominated by policies and guidelines produced by state agencies, it was teachers operating at institutional and classroom levels who determined what was delivered to student nurses as they relied upon their experience of teaching and clinical practice to plan and implement curriculum. Notwithstanding both national and local aspirations to the contrary, teaching and assessment practices were mostly teacher- rather than student-centred, with heavy reliance on propositional knowledge.

CONCLUSION

The practices identified within this study may induce approaches to learning that may be antithetical to delivering research based care within a prevailing climate that advocates evidence-based practice, clinical effectiveness and governance.

Reforms in nursing education across Western Europe: from agenda to practice

The overall goal of this research was to analyze implementation processes translating the nursing education reform agenda into practice across 20 Western European countries. The analysis centered on the substantial changes in structure and ethos created in nursing programs and the adjustments required from nursing faculty members as part of their integration into higher education institutions. Based on the model of implementing organizational change by Pettigrew, Ferlie, and McKee, three major implementation domains were analyzed: (1) the adjustment of nursing faculty members into higher education settings and toward their new roles; (2) the applicability of the graduate profile; and (3) the adequacy of the nursing curriculum for higher education institution and the reformed health care systems. A critical analysis of the scientific literature and policy documents revealed a striking similarity with regard to the difficulties and concerns appearing in the various Western European countries implementing nursing education reforms. Three sorts of difficulties emerge repeatedly in the reforming nursing education programs. These difficulties are related to (1) the adjustment of nursing faculty members into higher education settings and toward their new roles, (2) the competencies held by graduates of preregistration programs, and (3) the content and structure of the nursing curriculum. Future questions, lessons, and potential directions are discussed in this article.

Peer learning partnership: an innovative strategy to enhance skill acquisition in nursing students

The development of clinical skills for nursing students is a critical component of any undergraduate nursing program. Providing sufficient quality experience for students to develop competence has been recognised as a problem in skill acquisition. At the same time, peer learning has been identified as a valuable strategy for teaching and learning. Nurse academics at a Sydney university recognized these facts and implemented a peer learning strategy into existing first and third year nursing therapeutics units of study. This innovative approach linked the Australian Nursing Council Inc (ANCI) standards of practice to skills acquisition, resulting in third year students increasing their understanding of the relevance of these competency standards to practice. The peer learning strategy involved partnering first and third year students for clinical skills practice sessions. Evaluation of the peer learning approach indicated students valued the experience.

Implementing objective structured clinical skills evaluation (OSCE) in nurse registration programmes in a centre in Ireland: a utilisation focused evaluation

This paper presents findings from a research study of two objective structured clinical skills evaluation (OSCE) processes that were used in the new BSc. in General and Psychiatric Nursing Registration programmes offered in an Institute of Technology in the south west of Ireland. OSCEs, which have gained widespread acceptance throughout the western world as valid academic measures of nursing competence has yet to be established in this country. This research aimed to evaluate the process and outcomes of OSCE from the perspective of the major stakeholder groups: first and second year nursing students, lecturers, clinical placement coordinators and assessors. A utilisation focussed evaluation approach was adopted which values the opinions and experiences of stakeholders. It is intended to use the findings to develop the validity and quality of the OSCE assessment. The OSCE process was found to have a positive impact on all stakeholders. OSCEs were perceived to be a meaningful and fair form of assessment. Students identified that they felt more prepared for and more confident about forthcoming placements. The OSCE process was, however, perceived to be a stressful experience and requires considerable preparation effort by students and academic staff. Mature students claimed that more practice effort was required but also felt more prepared for placements and achieved higher OSCE scores.

Implementing competency recommendations into pre-registration nursing curricula: effects upon levels of confidence in clinical skills

The competency based pre-registration nursing curriculum was introduced to address concerns about levels of confidence and competence in skills of newly qualified Project 2000 educated nurses [Department of Health, 1999. Making a Difference: Strengthening the Nursing, Midwifery and Health Visiting Contribution to Health and Healthcare. The Stationary Office, London]. This study sought to examine whether the implementation of the competency recommendations has led to improvements in the confidence of nursing students in their clinical skills. A self-administered questionnaire examining ratings of confidence in areas of nursing practice and core competencies as specified by the Nursing and Midwifery Council (NMC) [UKCC, 2001. Requirements for Pre-registration Nursing Programmes. UKCC, London] was administered to 139 final year adult nursing students who were studying with the Project 2000 or competency curriculum. The response rate was 53%, results indicating that the students studying the competency curriculum have higher levels of confidence in all areas of their practice targeted by the competency recommendations than students studying in the Project 2000 curriculum. The positive effect that the competency recommendations had upon levels of confidence in nursing practice, and the implications of such changes to curricula are discussed.

Assessment of clinical practice in intensive care: a review of the literature

Nursing is a practice-based discipline, with clinical practice forming the heart of any programme of study. The major goal of all programmes should be on facilitating students to develop the skills necessary for competent and compassionate practice. Assessment of clinical competence is a fundamental aspect of programme development and as such deserves attention during the curriculum design process. The literature on assessment of students in clinical practice suggests that the tools used have evolved through various stages, ranging from the use of simple check list and rating scale to the development of competence assessment tools. Each stage has been fraught with difficulties and has taxed nurse educators, clinical assessors and students alike. The literature also indicates that there is a limited range of research available on clinical assessment tools, especially with an intensive care context. In part one of this two-part paper, the literature on assessment of clinical practice is explored, with specific emphasis on the assessment of competence with the Intensive Care environment. Part two of the paper reports on the findings of a study on students perceptions on a clinical competence assessment tool, used in an Intensive Care environment.

Do New Graduates of Registered Nursing Programs in Israel Perceive Themselves as Technically Competent?

BACKGROUND

Technical competency of graduate nurses is a much sought after commodity by nurse managers in this age of limited human nursing resources. Clinical coursework in nursing school should provide the graduate with the core skills necessary to function safely and competently in a variety of clinical sites.

METHODS

The research presented in this article examines the self-reported competency of 256 recent graduates of four different types of nursing programs in Israel, with respect to 53 technical skills. Information was collected via a structured questionnaire.

RESULTS

Graduates generally perceive themselves as competent, although levels of competence varied for the different skills. Type of nursing program, opportunity for skill practice in nursing school, and employment in a healthcare facility were found to be related to competency.

CONCLUSIONS

Suggestions for improvement in competency levels, such as the provision of more opportunities for practice, are offered based on the specific findings of this study and in light of previous research.

Moving from novice to expert - the value of learning in clinical practice: a literature review

The Fitness for Practice Report (UKCC 1999) acknowledged the importance of competent nursing practice and shared the responsibility for achieving this by making United Kingdom National Health Service employees jointly responsible for this with higher education teachers. This article presents a wide review of educational literature, to discover how both the constructivist and the sociocultural approach to learning will promote nursing expertise. Consideration of both these approaches to learning is germane to pre and post registration nursing courses, given that learning is both culturally situated and individually constructed from a variety of different sources, and the review demonstrates the pivotal position of the mentor and other practice teachers.

The Competence of Nursing Graduates from Problem-Based Programs in South Africa

Although a significant body of research regarding problem-based learning (PBL) programs has been conducted during the past 2 decades, most of it relates to medical students and their curricula. There has also been very little research in the context of developing countries. In South Africa, most of the students who are admitted into nursing programs are from disadvantaged backgrounds, and it is important to assess the extent to which process-based curricula are appropriate for this group. The purpose of this study was to describe and evaluate the outcomes of PBL programs in nursing schools in South Africa in terms of the actual clinical practice and competence of graduates, and to compare these outcomes with those of graduates from conventional programs. The objectives of the study were to identify the characteristics of practice of graduates from PBL and conventional schools of nursing in South Africa, as described by the graduates and their supervisors, and secondly, to compare the practice characteristics of the two groups.

Nurses' perceptions of their pharmacology educational needs

BACKGROUND

Pharmacology education in nursing has become increasingly important as nurses' roles in administering, prescribing and educating patients about their medications have grown. Some authors have expressed concern at the lack of science teaching in nurse education, and others have suggested that there is a theory-practice gap in this area of the curriculum.

AIM

This paper reports a study to explore nurses' pharmacology education needs by identifying nursing roles that require pharmacology knowledge, and nurses' preparation for practice from preregistration pharmacology education.

METHOD

A qualitative approach was used to collect data from a purposive sample of 10 qualified nurses from an emergency admissions unit in a city in the north of England. Semi-structured interviews were transcribed verbatim and categorized using Burnard's 14 stages.

FINDINGS

This study revealed a limited understanding of the subject, and dissatisfaction with the teaching of pharmacology, with resulting anxiety on qualifying. Nursing roles identified as requiring pharmacology knowledge included drug administration, patient assessment, nurse prescribing, and patient medication education.

CONCLUSION

The findings suggest that, although nurses have a limited understanding of pharmacology, they recognize the need for pharmacology knowledge in practice. Improved pharmacology teaching might increase nurses' confidence in performing drug administration, patient education, and nurse prescribing, and decrease anxieties related to these roles.

Devising and establishing the face and content validity of explicit criteria of consultation competence in UK primary care nurses

AIM

The aims of this study were (a) to devise a set of prioritised criteria of consultation competence which primary care nurses need to acquire and (b) to determine the face and content validity of these criteria.

METHOD

The criteria of consultation competence as contained in the Leicester Assessment Package (LAP) were modified for use with primary care nurses and sent to a stratified sample of UK primary care nurses (n=1126) to determine their face and content validity.

RESULTS

Support for the seven categories of consultation competence varied from 93-98% and for the 39 component competences from 88-98%. There was no consensus for alternative or additional categories or components. CONCLUSIONS; We have established the face and content validity of the derived competences. These are suitable for the teaching and assessment of consultation skills of primary care nurses, at all stages of their professional development, when incorporated within an educational package.

Irish diploma in nursing students' first clinical allocation: the views of nurse managers

AIM OF THE STUDY

To ascertain the views held by some Irish general nurse managers of the Diploma in Nursing students' first clinical allocation.

RATIONALE

Until 1994, nurses in Ireland were trained under a 3-year apprenticeship system and were employed throughout their clinical experience. In March 1997, the first intake of Diploma in Nursing students into one Dublin university were scheduled to commence their clinical placements. As this was the first time that supernumerary students were to be placed in the clinical areas, it was important to discover how effective the whole process was in terms of nurse managers' experiences.

RESEARCH METHODS

A grounded-theory approach, using unstructured interviews, explored Irish nurse managers' views of the impact of supernumerary students in the workplace. Ethical approval was granted. All available nurse managers in three general teaching hospitals linked with the university agreed to take part (n = 10).

RESULTS

Three themes emerged from the data, entitled 'Structure', 'Students' and 'Support'. In general, the managers believed that staff had had sufficient preparation for this change and that the whole process had been well handled. The respondents were pleasantly surprised by the students' abilities and interest in nursing. Minor problems were dealt with successfully at the local level and the support received by the students was found to be excellent.

DISCUSSION

Preconceptions of the students as more intellectual and less able for practical nursing were found to be untenable. The students' presence was welcomed and their questioning attitude, enthusiasm and application of knowledge was praised. Strong clinical support was required and students benefited from giving care, rather than just observing care given.

CONCLUSION

It is recommended that supernumerary students should be encouraged to give full care under supervision, in order to learn and to become proficient in all clinical skills. The next phase of change, transition to degree status for students from 2002, will benefit from lessons learned in the past 7 years since transition from certificate to diploma education.

Clinical competence assessment in nursing: a systematic review of the literature

BACKGROUND

The assessment of clinical competence has returned to centre stage of nurse education. However, there is little evidence to support the use of clinical competence and a wide variety of methods for its use.

RESEARCH QUESTION

The present study was designed to investigate the evidence for the use of clinical competence assessment in nursing.

DESIGN

A review using systematic methods of literature pertaining to clinical competence in nursing was conducted using defined dates, databases and search terms.

RESULTS

There is still considerable confusion about the definition of clinical competence and most of the methods in use to define or measure competence have not been developed systematically and issues of reliability and validity have barely been addressed.

CONCLUSION

The assessment of clinical competence remains almost universally accepted in the nurse education literature as a laudable pursuit yet there are aspects of it that remain at odds with the higher education of nurses.

The impact of part-time post-registration degrees on practice

AIM

This study aimed to identify how graduates from part-time, post-registration degree courses in nursing and midwifery perceived that their practice had changed as a result of the knowledge and skills acquired on their courses.

BACKGROUND

Despite increasing investment in continuing professional education and expansion of nursing roles, little work has been undertaken to assess the impact of graduates' skills on nursing care and clinical outcomes.

METHOD

Postal questionnaires were used to survey all graduates of post-registration Bachelor's and Master's courses in nursing and midwifery from one institution in the United Kingdom (UK) (n=60). Respondents were asked to describe how they felt their graduate skills were used in practice and if this was influenced by any factors in the workplace. Data were analysed descriptively, and by content analysis.

FINDINGS

Forty-three of 58 graduates contacted responded (74%). The majority (33/43, 77%) of respondents felt that their graduate skills were used in practice. Although most felt that their clinical practice had changed as a result of their degree studies, no practical examples of this were given, despite specific questioning. Many examples of academic and research skills acquired on the course were cited, which raises the question of whether the degree courses provided graduates with academic rather than clinical knowledge. There was ambivalence as to their perceptions of barriers in the workplace, which may have impeded the application of knowledge acquired on the courses.

IMPLICATIONS

The clinical effectiveness of education initiatives depends on the learners, the course and the workplace. To maximize the benefits accruing to patients from continuing professional education and role expansion, further exploration of the contribution of higher education programmes to clinical practice is required.

Student nurse satisfaction levels with their courses: Part II--effects of academic variables

The degree of student satisfaction with their educational experiences is an important dimension in the assessment of institutional effectiveness. All nursing education teams are currently working on ways to improve the quality of their educational provision and increase the satisfaction of their students. This is the second of a two-part article on the factors that influence student satisfaction with their courses. Part I examined how the four demographic features of gender, disability, ethnicity and age influenced student satisfaction and their performance on nursing modules. This paper complements Part I by examining the effects of three educational factors (academic level of the module, mode of study, and the qualification aim) on the accomplishment and satisfaction levels of 460 students attending multidisciplinary health care modules at the School of Health Care, Oxford Brookes University, 2000/2001. The study found that in contrast to Level 1 students, Level 3 participants felt the need for modules to stimulate more interest, that module teams be more skilled and knowledgeable and that library resources be more abundant. The findings also suggested that part-time students required significantly more attention than full-time participants in terms of the need for smaller seminar groups that would facilitate contributions and decrease inhibitions among students, and were more concerned with the utility and relevance of their learning in relation to their chosen professions. Diploma participants had the highest satisfaction followed by the BA and then the BSc students. The findings raise issues which are of interest to academic staff and nursing students, and the implications for nurse education and curriculum design are discussed within the context of student nurse satisfaction and quality issues of learning and teaching in higher education.

Facilitating the development of clinical skills in caring for dying people in hospital

Research shows that diploma level preparation has resulted in newly qualified nurses with clinical skill deficits (e.g. Macleod Clark et al. 1996, Carlisle et al. 1999). Part of the government's current plan to improve the quality of services delivered by the NHS is to address this problem through the introduction of a new nursing role; a role incorporating both clinical practice and teaching (Department of Health 1999). This paper draws data from a phenomenological study of 28 qualified diplomat nurses. It identifies their self-perceived skill deficits in relation of caring for dying people in acute hospital medical wards, and the ways that they believe that they could best be helped to overcome these deficits. On the basis of these findings, strategies are recommended that a practitioner-educator might adopt, with the intention of facilitating skill development in the care of dying people.

The meaning of preceptorship: nurses' lived experience of being a preceptor

AIM OF THE STUDY

This phenomenological study is aimed at illuminating nurses' lived experience of the process of preceptoring and the meaning of preceptorship in a Swedish context.

METHODS

Seventeen nurses from the North of Sweden with varied previous experience of preceptorship volunteered to participate. Their narratives, describing their experience of being a personal preceptor for a student nurse during practical training on a hospital ward in the third year of a 3-year diploma programme within a university college of nursing in Sweden, were transcribed verbatim. A phenomenological-hermeneutic interpretation disclosed the themes 'sheltering the students when learning' and 'facilitating the students' learning', together with eight sub-themes, which created an understanding of the meaning of preceptorship.

FINDINGS AND DISCUSSION

The meaning of preceptorship was understood as reducing the risk of the students learning helplessness and empowering the students when learning in practice. The meaning of preceptorship highlighted the need for further preceptor support and development of the role of the preceptor. On the basis of the findings, suggestions were made to increase the preceptors' awareness of values in nursing practice and use of pedagogical strategies in the process of preceptoring. Through such strategies a reciprocal development of the preceptors' and the faculty's knowledge may take place, to the best advantage of the students' learning and the development of the profession.

Nursing competencies: personal characteristics contributing to effective nursing performance

AIMS OF THE STUDY

Core competencies are important in enabling an individual to adapt to new environments and perform superior professional practice. This study was to identify the underlying competencies which contributed to effective nursing performance.

BACKGROUND

Most of the previous competencies are either derived from researchers' conceptual analysis or based on practitioners' direct report. Competencies derived from these methods either are subject to bias or are unable to identify the essential elements for effective nursing care.

METHOD

Following the McBer method, 50 experienced nurses in China were asked to report 82 valid critical incidents in their jobs. Two individuals coded the scripts and decided the presence of each competency according to a pre-established coding system.

RESULTS

Ten competencies including interpersonal understanding, commitment, information gathering, etc. were identified. Each competency was illustrated by behavioural indicators.

CONCLUSIONS

Skills, traits, motives and attitudes all contribute to effective nursing performance. The findings assist in the delineation and development of nursing competencies and thus provide realistic working behaviours for nursing education and management.

Evaluating preceptorship arrangements in a paediatric setting

Preceptorship can be a valuable support mechanism for newly qualified nurses. Both preceptors and preceptees need support to ensure effective preceptorship arrangements. Maintaining effective preceptorship arrangements can be challenging for preceptees, preceptors and the organisation. Further research is required to explore the full potential of preceptorship.

The biological sciences in mental health nursing: stakeholders' perspectives

To date, relatively little attention has been paid to optimizing the development of education programmes to support safe and effective health care professionals. In particular, the wider stakeholders, particularly health service users, are rarely consulted on the knowledge base expected of practitioners. We report here on an evaluation, involving students, lecturers, nurses and service users, aimed at reviewing the bioscience component of the preregistration mental health nursing course. Students and lecturers agreed that the current common foundation course in bioscience was biased towards the adult branch students, and failed to meet the needs of mental health nurses. The mental health lecturers' solution to the 'bioscience problem' was to curtail the input. In contrast, service users described serious shortfalls in professionals' abilities to inform them of common side-effects of medication; these problems were attributable to inadequate educational preparation. The knowledge deficits identified could be rectified by making pharmacology an important part of the mental health education programme. However, for the curriculum to accommodate applied pharmacology, its supporting bioscience, and essential preparation in psychosocial interventions, some restructuring of the biological science programme for mental health nurses will be necessary. Our findings suggest that such restructuring should be informed by service users' views of their needs.

Did Project 2000 nurse training change recruitment patterns or career expectations?

In the UK, Project 2000 nurse education, introduced over the last eight years, aimed to increase the professional status of nurses and enhance skills, focusing on wider community care. This paper reports some of the results from a research project conducted between 1994 and 1996, funded by the Department of Health (Project 2000 Fitness for Purpose 1996). It was hypothesized that the changes in Project 2000 training might attract those more academically qualified and lead to more rapid career progression. The results found in this study did not support either of these hypotheses and suggestions are made about the reasons for the negative findings.